Recreation of twenty patients of the state hospital for mental diseases at Howard, Rhode Island

Boston University

SCHOOL OF
SOCIAL WORK

LIBRARY
#

Gift of

mm- 1

BOSTON UlTIVERSPTT
SCHOOL OF SOCIAL WORK

RECREATION 0? T\YSNTY PATIENTS OF
THE STATE HOSPITAL FOR miTAL DISE'\SES AT
HO.VARD, RHODE ISLAM)

A Thesis
submitted by
Roy John Hartmann
(A.B,, Columbia University, 1939)

in partial fulfilment of requirements for
the degree of Master of Science in Social Service

1941

LIBRARY
BOSTON UNIVERSITY

SCKOOL OP SOCIAL WORK

/

Approved by:

First Reader ^^u^t^^y^uMi c^<Kt-vU-/

Second Reader A^^^.^*^^^ , ,^^^^.<m.*^

rORlTiVORD

Appreciation is here acknowledged to
those individuals, personally and impersonally
known, who have contributed in various ways to-
ward making the production of this thesis both
interesting and valuable to the writer; I hope
it proves such to those who read it.

To all those who so generously coop-
erated at the State Hospital for Mental Diseases
where this study was made, many thanks are due.
To the clinical director. Dr. Harold W. Williams
the writer feels indebted for his consideration
in making available the data used in this study.

TABLE OF CONTEl^TTS
CHAPT^IR PA0T5

I. INTRODUCTION 1

II. A CONCEPT OF REGREA"^ION 5

Humor as predominantly psychological recreation . 6

Play as predominantly physiological recreation . • 7

Play differentiated from work 10

Definition of recreation 15

III. THE I.IETHOD 16

Fundamental psychological needs of personality . . 16

Qualitative rather than quantitative approach • • 17

Selecting a group of patients 18

Three sources of data 20

The * recreationa 1 period' 21

Factors conditioning selection of recreation • • • 27

IV. THE T'lWTY PATIENTS 30

Clarification of terminology 30

The twenty cases 34

V. ANALYSIS OF THE DATA 50

Relation of recreation to conditioning factors . • 50

Relation of recreation to psychological needs • • • 59

VI. CONCLUSIONS AND RECOmTENDATIONS 65

Method 65

Findings 66

Further research 70

BIBLIOGRAPHY 72

LIST OF TABLES

TABLE PAGE
I. Relation of Age to Passive and Active

Recreation 51

II. Relation of Age to Indoor and Outdoor

Recreation 52

III. Occupational Therapy as V/ork or Play 56

IV. Religious Feelings and Attitude Toward

Embroidery 57

CHAPT^ I
INTRODUCTION

In recent time with the growing complexity of cul-
ture and its accompanying strains and stresses, recreation,
as one means of relieving the tension of modern living, has
become more important. As one scrutinizes the mushroom
development of recreational facilities, he begins to become
conscious of the lack of an underlying theoretical founda-
tion behind the present day play movement. It is not mere-
ly a matter of theoretical consideration, however, but con-
jointly a consideration of practical import, for wilh out the
proper appreciation of the meaningf ulness of recreation,
there will result a hodge-podge of activities without a well
thought out plan for the development of facilities.

Only a limited and very special aspect of the gen-
eral field of recreation will be studied in this paper, tha%
of the value of recreation for the mentally ill. In mak-
ing such a study one is struck with the widespread lack of
agreement as to what is meant by recreation, and one also
finds that no practical or experimental investigations of
the field have been made, partially perhaps because of the
complexity of the subject and partially because of the vague
ness of what we mean by recreation. One is faced at the

outset by such questions as whether sleep, religion, swear-
ing and drinking are recreational activities or not.

Because of this laxity in the use of the term
•recreation*, this writer has first spent considerable
space in formulating his own concept of the recreational.
The rest of the paper is an attempt to explore the possi-
bilities and values that recreation might have in the treat-
ment of the mentally ill.

The next step after a concept of the recreational
had been developed was to find a group of patients whose
activities could be evaluated as to their recreational char-
acter. More than the formal recreational periods were tak-
en into consideration, since it was suspected that perhaps
some of the patients benefited from forms of amusement which
they spontaneously engaged in on the wards in addition to
the value they received from scheduled recreational periods.
It was thus felt necessary to study the twenty-four hour
activity of the patients selected. Because it was impossi-
ble for the author to continually observe the patients* activ
ities, recourse had to be taken to the written records kept
on the wards. The Adolph Meyer Building of the State Hospi-
tal for Mental Diseases of Rhode Island was selected as of-
fering the necessary records. Twenty patients were chosen
from this building for the purpose of the investigation.

I

t

(

The other buildings of the hospital, although offering suit-
able subjects, failed to provide adequate records, since
limitations in facilities and lack of sufficient staff mem-
bers make comprehensive recording impossible. The recrea-
tion of the patients selected was divided in to that engaged
in before and during hospitalization, the expectation being
that concomitant with the total emotional change in the life
of the patients, there would be a reflected alteration in
the recreational life.

A method of studyins: recreation had to be developed.
Since recreation is considered in this study to be attitudin-
al in nature, rather than comprised of any particular set of
activities, a way of studying it was sought which would eval-
uate the recreational activities in terms of feeling tones.
An arbitrary but useful division was set up to categorize
fundamental psychological needs or feeling tones of person-
ality which could be considered with respect to the §xtent
to which the recreational activities did or did not p-ive ex-
pression to them. The small number of cases and large num-
ber of these divisions did not permit extensive conclusions,
although any other kind of evaluation, such as a listing of
the recreational activities engaged in, seemed to lack clar-
ification of the me aningf ulness of the activities to the
individuals .

Throuf'hout , this thesis is exploratory in nature.

The conclusions, although meager, perhaps at least suggest
a possible way of studying the increasingly important sub-
ject of recreation.

The view that is put forth in this paper is that
recreation is essentially attitudinal or psychological in
nature rather than determined by any set activities. Act-
ivities, however, may be predominantly psychological in na-
ture, as humor is, or may be primarily physiological in
character, as in football or baseball, although the charact-
erizing element in both cases is psychological, so that we
are led back to a consideration of the psychological level
as an expression of recreation in its clearest form. Since
humor is recreation on the psychological level, a considera-
tion of it in the following pages is first presented, so
that the reader may first gain in more accentuated form the
elements of the recreational. Then the more obscure but
yet important physiological expressions of recreation are
considered. The study itself, however, does not discuss
humor so extensively.

? ■

I

I

CHAPTER II

A CONCSPT OF RECREATION

If an adequate study of recreation in a particular
situation is to be made, a definition of the general meaning
of recreation seems important in order to clarify what is
being investigated. Moreover, in defining recreation, the
meaning fulness oj^t will reveal itself. v;ithout a well-
formulated concept of recreation it is not only impossible
to carry on an investigation of its place in a specific sit-
uation, but its function will correspondingly be nebulous.
It is worthy of note that our definitions of basic studies,
such as sociology, psychology or philosophy, reflect one*s
understanding of the function of each. In psychology, for
example, 7/atson defined this science in behavior istic terms,
while Titschener, who conceived psychology in a different
manner, expressed his understanding of the nature of this
study in terms of introspection.

One of the accepted principles in psychiatry today
is that all behavior is purposeful. When certain forms of
behavior, such as eating and drinking, are examined, the ne-
cessity of such activity for the continuance of life seems
apparent, but other modes of behavior seem to have little or
no meaning for human beings,

Humor is one of those forms of behavior that looks
so simple and meaningless that scientists have, until recent
times, neglected to scrutinize it to determine its importance.
Sigmund Freud has probably done more than any other person to
clarify the purpose of humor. It has been shown that the con-
tent and form of a joke are not accidental but are rQ*^®^ r®"
lated to the specific needs of the individual. If one consid-
ers for a moment the natiire of jokes concerning mother-in-laws
or absent-minded professors, he will see a tinge of hostility
expressed in the disguised form of a joke. Since the mores
of our society do not allow of much more overt expression of
hostility toward mother- in-laws or other persons who are often
a source of disturbance to us, jokes are circulated which al-
low a release of our emotions in this socially acceptable
manner.

Another indication that humor is a product of civil-
ization is found, as A. A. Brill suggests"^, in the observation
I that primitive tribes and young children have little in the
way of a sense of humor. Only as civilization develops does
humor appear to gain in importance. V/hen the brutal impulses
of the savage are overtly expressed, there i^no need for wit.

This knowledge of the role of wit is utilized today. Studying

1 A. A. Brill, ''The Mechanisms of 7/it and Humor in
Normal and Psychopathic States", The Psychiatric Q,uarterly ,
14:741, October, 1940.

a person's favorite jokes, which will be the ones from which
he derives the most pleasure, is a method used by some psy-
chiatrists in an attempt to locate the area of difficulty
within those they are treating.

In addition to the expression of the tensions of
individuals by means of words, there is also the expression
of tensions through motor activity. If the character of the
tension is produced by an inadequate expression of the phvs-
ical needs of the organism, as in the sexual sphere, a joke
relieving the psychic tension does little to alleviate the
organic urge. It seems that here some sort of physical re-
lease is needed. On the other hand, if the tension is the
result of attitudes of one race for another, as in the jokes
about Jews, it would seem that humor, in this case, would
serve the purpose and that physical release would not be so
necessary.

Play, like wit, has long been allowed to go unex-
amined, resulting in a lack of understanding of the purpose
of play or recreation (the terms are used interchangeably)
in human life. Since it has been indicated that humor, a
form of recreation, has become increasingly important with
the development of civilization, it may be well to evaluate
the other types of recreation, such as those involving
predominantly motor activity, in order to determine whether

they, too, are playing a more important role in our culture to
day than in former years.

Although perhaps the greatest part of our effort
should be directed toward changes in our social and techno-
logical setup, it will be necessary to find methods of deal-
ing with those permanent tensions that cannot be eliminated
without the collapse of the society itself, since whenever
a group of individuals live together, it seems as though
there is a certain minimum amount of restraint required of
its members, no matter whether this be voluntarily or invol-
untarily imposed.

If humor has found its purpose in relieving in a
predominantly psychic way the tensions that necessarily result
from cultural development, it is perhaps possible that play
in the form of motor activity can also do something toward
relieving strains and stresses.

Play received little attention in the past until

the time of Karl Groos, who made the first comprehensive

2

study of the subject. ^ince Groos studied both the play of
animals and that of man, it seems that he interpreted the
two alike, so that, not only did he conceive of the playful

2 Karl Groos, The Play of Animals , (New York: D. Apple-
ton & Co., 1898)

activities of the young animal as a preparation for later
life, but he also thought of the play of young children as a
preparation for adulthood. If play is a preparation for
the child's adulthood, it would be supposed that when he was
matured he would not play any longer, although, as a matter of
fact, adults participate in various forms of recreation, too.

Herbert Spencer, however, even before Karl T-roos ,

advanced the idea that recreation is an expenditure of the

unused energy which individuals do not consume in pursuing

their ordinary activities, althoue-h he did not niake clear

why recreation takes various forms. He did say, however,

that recreation serves as a means of obtaining recognition

for those who are unable to do so in their work activities.

Mason and Mitchell report:

The research of the authors regarding the recreational
activities of men of varying professions indicate that
adults turn to activities in their leisure hours which
are very similar to those they engage in during their
work-a-day life; one would think that the lawyer might
engage in aviation, horseback riding, and northwoods
canoeing, but as a matter of fact, the majority lecture,
serve on committees, and argue in the smoking room of
their clubs. The newspaper reporter reads, attempts to
write stories, and dabbles in drama. The physical di-
rector engages in vigorous physical activity and watches
athletic sports. The engineer tinkers with radios,
electrical apparatus, automobiles, and building projects
involving the use of tools.

These types of professional men use the abili-
ties they have and do the things in which they know they
are proficient. In these activities they have a feeling
of mastery and success* In workin^^ hours they are some-
what hampered by routine duties but in play they have
freedom to follow their ovm abilities in desired ways.

10

Any activity for which one is particularly fitted is
usually engaged in with zest and spontaneity.

That the recreation of men and women is similar to their occu

:| pation, rather than radically different from it, seems to in-

I dicate that our customary viewing of recreation and work as

distinct entities is false and that human beings through

play express their native capacities and pursue their inter-

! ests to a fuller degree.

G.T .'.Y. Patrick interprets recreation thusly:

The principle involved in all the forms of relaxation
here studied is relief from tension or release from some
form of restraint. Although this tension and restraint
! on the part of the individual are necessary conditions

of all social evolution, they have been greatly intensi-
fied by the manner of life which characterizes the nine-
teenth and twentieth centuries. The repression of prim-
itive impulses to the end of growing social needs is the
fundamental law of human progress. Such continual re-
pression necessitates constant effort, constant strain,
and constant exercise of voluntary attention. It in-
\ volves those higher brain centers whose development has

:| conditioned human progress, and brings upon them a severe

|| and constant strain, making rest and relaxation impera-

tive .

II In discussing his concept of recreation or relaxation, Patrick
ll shows how alcohol, profanity and war are expressions of human

i beings in their desire to rid themselves of the tensions

ll

found in their cultures.

i

I Patrick here seems to give an essential attribute

3 Elmer D. Mitchell and Bernard S. TTason, Theory of
Play. (New York, A.S. Barnes and Co., 1935), p. 6B

|| 4 G. T.W.Patrick, The Psychology of Relaxation,

1' (Boston and New York: Houghton and MifflTn Co . , 1918) , pp.18-

[ 19.

of recreation, that of relievim tension, although, at the
same time, and he states this himself in his book, it does
seem odd to see grouped together profanity, drinking and war
as forms of recreation. One may look upon drinking as a
form of recreation and see nothing- unusual in so doing, al-
though it is interesting to observe the diversity of opinion
even in this respect. To look upon war as recreation, how-
ever, just because it relieves tension, is not so convincing,
and somehow one feels that war is too serious an activity to
be designated such. In war the primordial impulses of hate
and fear are allowed undisguised vent, whereas in recreation
there is a more modified expression of these feelin^?s. If
recreation is defined as that activity which allows release
of tension, sleep may also be looked upon as a form of re-
creation. But Patrick implies, although does not make ex-
plicit, that war, profanity and drinking are means of reliev-
ing the tensions developed from other related phases of life
which are biologically and psychologically basic, so that
the human organism, incapable of expressine' directlv its fund-
amental drives, is forced to seek other outlets. And accord-
ingly, it can be seen that sleep, too, like war, should not be
termed recreation, since it is a direct expression o-*^ organic
urge .

One of the essential attributes of recreation, then,
is the expression of basic psychological and biological needs

in a modified or diplaced form. V/hen fundamental drives of
the organism are allowed uninhibited expression, as in war,
the activity can hardly be called play.

Some writers make a rather abrupt distinction be-
tween work and play, although such a separation would appear
unjustifiable if one thinks of the unification of experience
in the individual. Besides, present day concepts have em-
phasized the continuity of relationships in the world, al thought
in thinking a necessary but artificial separation must exist.
Since the work and play of men and women seem related, accord-
ing to Mason and Mitchell's study, and people seem to attempt
to express themselves more fully through play, it might be
well to briefly examine the similarities and differences be-
tween work and play.

Aggression and superiority may be expressed in the
business office or on the football field, although the con-
sequences of defeat in the business world are more serious
than those resulting from losing in football. In both in-
stances there is a degree of suspension or risk, although in
play one feels that fundamentally he is secure.

7/ork is most often performed for the purpose of
making a living, although industrial research in factories
has indicated that other factors, in addition to the economic,

operate in determining the amount of satisfaction a person
obtains from his job. The feeling of being important to
the firm one is working for seems to help an individual de-

5

rive more pleasure from his work. Stuart Chase has stated
that wages often do not seem to matter to individuals so
much as their feeling of contributing to the production of
their organization.

The interest element in play seems to be more in-
tense than in work, although a sharp differentiation here
seems unwarrented. If a person disliked his position in-
tensely, it would be difficult to understand how he could
continue at it, even though he received a good wage. In
play, hof/vever, the individual is allowed to choose his activitj^
to a greater degree, begin and stop when he wishes and rest
when he likes. Another way of saying almost the same thing
would be to state that play and work can be primarily differ-
entiated on the basis of attitude rather than by specific
activities, although there are many factors, such as the in-
dividual's biological makeup and sociological influences,
that determine and limit the possible attitudes of individuals.

If recreation is not a particular, standardized

5 Stuart Chase, What Makes the Worker Like to Work'',
Reader* s Digest , pp. 15-20, February, 1941.

I activity but is rather one which contains a hip-h element of
I interest for the individual, the extent to which an activity
' is play can be measured by the degree to which it completely
! satisfies the basic psychological and physiological needs of
j the personality. But the habitual drinking of the drunkard,
I although it may allow him a cursory freedom from tension,
results in an intensification of the strain within the indi-
vidual. It is even questionable whether such drinking as
this can properly be termed recreation, since often the drink-
ing, according to modern day concepts, is an endeavor to for-
I get troubles. The interest in the drinking itself may even
be lacking, the drinker feeling unpleasantly compelled to
drown his sorrows.

Football, on the other hand, seems to release ten-
sions of the organism in a more complete fashion and for a
longer period of time, although the force of habit, which
operates in all phases of human activity, demands repetition
of any satisfying mode of behavior. The value of strenuous
I athletics is presented by Dr. Cannon:

In many respects athletic rivalries present, better than
modern military service, the conditions for which the mil-
itarists argue, the conditions for which the body spon-
taneously prepares when the passion for fighting prevails.
As explained in an earlier chapter, in competitive sports,

the elemental factors are retained man is again pitted

against man, and all the resources of the body are sum-
moned in the eager struggle for victory. ^nd because,
I under such circumstances, the same physiological altera-

tions occur that occur in anticipation of mortal combat.

the belligerent emotions and instincts, so far as their
bodily manifestations are concerned, are thereby given
complete satisfaction.

Summing up the various elements which seem to con-
tribute tovvard making an activity recreational, the following
definition is given as to what is meant in this study by the
use of the term:

RECREATION is an activity engaged in for its own
sake that displaces the individual's basic bio-
logical and psychological needs in such manner
as to make them socially acceptable.

6 Walter B, Cannon, Bod ilv Changes in Pain, Hunger,
Fear and Rage (New York and London, D. Appleton and Co., 1925)
pp. 296-7. *

nmvTm iii

THE IIETHOD

Because of the characteristic neglect in the past
to evaluate experimentally the place of recreation in human
living, there has been a resultant lack in the formulation
of a generally accepted mode of approach to the subject. In
searching for some way of measuring the factor of recreation
as conceived for the purpose of this study, it became appar-
ent that, since recreation is essentially attitudinal in
nature and is reflected only secondarily in certain activi-
ties, it would be found necessary to classify the elements
expressed through the medium of recreation on a psychologi-
cal basis. Accordingly, the following mode of classification
was selected for this study, although another way of categor-
izing fundamental psychological needs of mankind could prob-
ably be used just as easily. The following is a terse pre-
sentation of these elements:

1. Freedom of the individual to select the activity in
which he engages

2. Expression in terms of reality rather than phantasy

3. Release from depression and self -accusation

4. Superiority expression, measured in respect to a group
of other persons

5. Sociability of subjects, measured with regard for the
extent and character of its expression

<

(

6. Experience of greater security

7. Esthetic experience

8. Mastery of self or an object

9. Desire for new experience

An examination of these elemental psychological
needs of the individual that were observed for their expres-
sion through the medium of recreation will make clear that
there is great difficulty involved in formulating them Quan-
titatively. Because of this fact and the appearance that
recreation is probably intricately bound up with the total
life experience of the individual and is possibly an effort
to express more fully the needs and potentialities within
the personality, the most profitable way of studying the sub-
ject of recreation seemed to be that of studying the pattern
of each subject's behavior and scrutinizing recreation to
determine how it gave expression to the individual's pattern.
It was felt that a mere statistical analysis of the recrea-
tion of a large group of individuals would be helpful only
after a detailed study of a case work nature had been under-
taken in order to determine those factors which with profit
might be studied by means of the statistical method. It
will be realized, however, that the method used in this study
is exploratory in character. In further studies it may be
that a different method of approach altogether will be found
most profitable.

18

In looking for a group of persons to study, it was
thought necessary to select a group whose almost, if not every,
activity was accounted for, so that a complete picture of the
individuals* twenty-four hour experience could be had. A
mere listing of the various activities of persons, however,
did not seem to be adequate for a comprehensive picture of
the meaningf ulness of the activities to the individuals.
Accordingly, it was felt that it would be necessary to ob-
serve human beings to determine the degree with which they
were participating in various activities. It is hard to
tell by merely looking at a person whether he is really e-et-
ting little or much out of an activity, so that particular
actions of individuals were to be noted so that some substan-
tiation could be given for saying that the observed felt such
and such. A group that seemed to present favorable material
for the study was found in the patients of the Adolph Meyer
Building of the State Hospital for Mental Diseases at Howard,
Rhode Island. '^he advantages of studying the recreation of
mentally abnormal persons seemed to be that it would perhaps
show more clearly the function generally of recreation in the
lives of men and women. The foundation for this suspicion
rests upon the hypothesis that recreation is essentially atti-
tudinal or emotional in nature. Since the mentally ill are
characterized by mood disturbance, one might expect to find

that their emotions would exhibit themselves, as far as

recreation is concerned, through activities different from
those engaged in by so-called normal persons. This group
also offered opportunity to the writer to observe them dur-
ing the recreational activities. In addition to these ob-
servations, there were those of the nurses in charge of the
several wards from which the patients came. Perhaps one of
the most important factors was that of the existence of fair-
ly complete records of the daily doings of the patients in
this building.

The Adolph Meyer Building is the best equipped build
ing of the hospital, having better material surroundings, more
psychiatrists in proportion to the number of patients, more
extensive nursing care, greater services of hydrotherapy and
physiotherapy and better recreational facilities. It is the
building of the hospital in which all of the modern skill is
concentrated in the hope of speedily restoring the ill to men-
tal health once more. Often by subjecting some of the pa-
tients to the many favorabl© forces in this build ins;, he is
quickly enabled to leave the hospital to return to the com-
munity, although not every patient appears to benefit from
the individualized treatment available in this building.
None of the violent patients are kept in this building. "Tien
a patient tears down screens or breaks windows, he is consider
ed violent and is sent to one of the other wards.

Four wards in the building are used at the time o-^
writing. On wards five and six the men are housed, the ones
who are almost ready to go home being on ward five. On wards
two and three the women stay, those on ward two being consid-
ered almost well enough to go home. Those on wards two and
five, since they are almost ready to go home permanentlv, are
allowed to go home for short visits at first which are of two
or three days duration, so that they mav become accustomed to
life outside the institution. No record could be kept, of
course, of the activities of the patients while at home. Be-
cause of this it was felt better to select as manv of the pa-
tients from wards six and three as it was possible. Conse-
quently a total of fourteen were selected from these two wards
Not only is there greater information concerning the continued
twenty-four hour activity of these patients, but they are all
ill to about the same degree. As the study progressed, how-
ever, it did not seem so necessary to know the continuous act-
ivity of the subjects and in addition it became noticeable
that on wards two and five there were available for st'idv some
patients who engaged in a great deal of recreational activity.
Six of these were included in the study, making a total of
twenty patients studied.

Three means of gathering data about these patients
were available. On every patient who enters the hospital,
no matter whether on a voluntary or involuntary basis, as

much information as possible about his life previous to hos-
pitalization is gathered in the hope of shedding light upon
the reasons for his mental illness. Such a systematic or-
ganization of the patient's experience before his hospitaliza-
tion is called a history. This source was used in every case
although in almost every case the recreational activities were
given only slight mention. Another way information was col-
lected about the subjects studied was by means of examining
the nurses' notes, which are daily or at least weekly reports
by the nurses in charge of the wards of the outstanding beha-
vior of the patients. The advantage of having these notes
was great, for it helped to give a good understanding of the
progress, or lack of it, of the patients from week to week.
Perhaps the most important source of data was that of direct
observation of the studied patients during the recreational
period itself.

The 'recreational period' at which the writer made
all his observations was a two hour period from seven to nine
in the evening. ^o regular days in the week were given over
to this period, since it was felt a more flexible program was
desirable in order to fit in with the changing needs of the
patients. At times the patients did not attend the recrea-
tional period for six days, although this was considered ra-
ther long to go without it, because they appeared restless or
overstimulated. Usually patients met together for their

amusement two or three times a week.

In order to give some idea of the group situation
in which the patients participated two or three evenings a
week, a description of the physical and social aspects of
j this 'recreational period* will be given. The room in which
the activities were carried on is twenty-five by fifty feet
in dimensions with a medium high ceiling of twelve feet or
so. As one looked around the room he saw six large windows
on one side of the room and six doors on the other side. The
floor was painted a deep green, the walls seemingly reflect-

I ing a lighter green, the total effect of which was one of

i

j restfulness. Around the room about thirty wooden chairs
I were placed. Located against a wall was a piano, an upright
j with good sound. Hong one neighboring wall was a victrola
I of old-fashioned build. The quality of the music did not
j equal that of the piano. Indirect lighting reflected against
i a lily-white ceiling. The light seemed to have a stimulat-
ing effect.

Once every two weeks the '7 .P. A. orchestra, which
I plays at many of the dances of the hospital, played for one

i hour, rendering both jazz and stately music. The Quality

i

i of the music seemed to be g§od, the patients awaiting the

j coming of this six-man orchestra eagerly. '.'>/hen this special

I music was not accessible, one of the patients would usually

play the piano while the others danced. At other times the
victrola was turned on and patients enjoyed this, althou^^h
there was a marked preference for the piano music, possiblv
because the victrola was not considered to be of such hi^?h
quality and the records were somewhat out of date. Besides
this there seemed to be a desire to hear one of their own
group play.

In addition to this music already mentioned there
were played on occasion the guitar, harmonica and accordian.
Tov;ard the end of one period, just before the patients had
to go to their wards to retire, a group of five gathered in
one portion of the room, two of them supplying music with the
guitar and harmonica, one dancing wildly and the other two
cheering. They seemed to have a merry time. Once in a
while an accordian solo was played, although this was rare.

Singing was engaged in, too. Both love sonf^s and
old-fashioned tunes seemed to be most popular. With some
leadership the patients would gather around the piano and
sing. Those vvho remained in their chairs did little but
look on. Solo vocal renditions were enjoyed by the patients,
a soloist almost always being forced to sing encores.

The Virginia Reel was very popular among the men
and women. A leader was usually picked and he would direct
the others. Hearty laughter accompanied any mistakes that

24

were made, although considerable concern was shown for the
feelings of other persons.

Although these v/ere the only group forms of recrea-
tional activity in the Adolph Meyer Building, individual pa-
tients engaged in solitary modes of play on the wards. Di-
rect observation of these patients by the writer was not un-
dertaken.

The usual attendance was about twenty-five, althouf!;h
on at least one occasion there were thirty-five present. To-
men outnumbered the men two to one. "Because of the relative-
ly few men present and because they often could not dance,
only six to eight couples danced at a time. Sometimes there
would be only two or three couples on the floor, although the
women usually danced with each other. Y/hen the 'V."^.'^. or-
chestra played for the group there was a regular response of
couples to the music, more individuals dancing than at any
other time. Musical favorites were requested of the orches-
tra by the patients, there being no prescribed list of pieces
to be played.

About one third to one half of the patients merely
sat around the room and did not participate in the doings
about them. A few of them, in fact, on occasion attempted

to withdraw from the room. The reason for having these pa-
tients attend recreation was to expose them in the hope that

c

they would later participate in the activities. Of those
who were well enough to engage in other forms of recreation
and who did not care for the music, some played cards.

In order for the writer to study the recreation of
the patients he had to observe them, as one means of approach,
but this meant that he had to remain in the same room with the
patients at the time when they were having their recreation.
It was felt that some of the patients would wonder why another
person was continually present and watching them. Such a
position on the observer's part seemed difficult, so that it
was considered more profitable to participate in the activi-
ties with the patients. This removed any feelings that they
might have had of being watched. Otherwise, behavior on
their part might not have been very natural and spontaneous.
By dancing with the patients the observer was able to obtain
facts which otherwise would not have been forthcoming to him.
The graceful dancing of some of the patients was revealed in
this way.

Another important result of the observer's participa-
tion in the group activity was that from leading some of the
activities a better understanding of the importance of leader-
ship v^as obtained. Some of the group singine was led by the
observer .

It was not an easy task to say that the improvement

of the patient, where suoh was indicated, was due to recrea-
tion or other factors. Although the same problem h^d to be
considered in evaluating the effect of occupational therapy,
psychotherapy and other influences, the problem was more
outstanding concerning metrazol and insulin treatment because
of the marked difference in mental health that often results
from a few treatments. In almost any case, the general feel
ing among psychiatrists seems to be that all factors contri-
bute to some degree toward restoring the patients to mental
health. Because of the improvement in mental health the
metrazol shock therapy makes a difference in the degree to
which patients engage in recreational activities or in any
other activities. It can hardly be said that it is the re-
creation that is the chief factor in helping such patients
regain mental health. This question of whether a patient
played because he was getting better or whether through play-
ing he was helped markedly to improve was one of the consid-
erations that was kept in mind during this study. If two
well-rounded programs could be coT^pared, one leaving out the
recreational factor, the effectiveness of play in helping the
patient get well might be evaluated.

Certain considerations seemed to be important in
making a difference in the recreational life of the patients
before hospitalization, considerations that did not necessar-
ily seem related to the mental disease of the patient. An

27

1

1

effort was made to study all these important factors which
seemed to be involved, For the sake of brevity in the text,
each factor will be assigned a Roman numeral and referred to
hereafter by its number. It will be noticed that the finan-
cial aspect is not considered here. In other studies this
certainly woulci be important to take into consideration; in
this study all the patients are about of the same financial
status. Otherwise, they would have no doubt been sent to
a private institution. For persons of limited means there
must be a curtailment of attendance at operas and the like,
so that it can be readily understood how this factor would
influence one^s forms of recreation. The factors other than
financial that seemed important for this study are as follov/s:

I. Age. Old men and young do not engage in the same types
of recreation, the seventy year old man scarcely engag-
ing in football any longer.

II. Residence. It was thought that perhaps rural persons
might not be able to engage in the same activities as
those of the city individuals.

III. Psychosis. Another factor which was studied for its

relation to the recreational activities engaged in was
the psychosis of the patient. It might well be ex-
pected that the manic patient would engage in active
recreation while the schizophrenic patient would engage
in a-social pastimes.

IV. Occupation. Since, according to the findings of Mason
and Mitchell, the vrork and play life of the individual
seem to be related, it was felt important to consider
the relationship of the subject *s play to his work.

V. Color. V/hether a person is white or black may make a
difference if he lives among individuals who have a

28

skin color different from his ov/n . At least this factoi
should be considered for its possible importance.

VI. Marital Status. It seems that after a person marries
there is a change in the character of his recreational
activities. Dances, for one thing, are not usually
frequented so often as when the parties involved were
single .

VII. Nationality. A person living in a culture different
from his may have a hard time in enjoying the same forms
of recreation as those about him, A Russian who did
not understand English at all would derive little pleas-
ure from listening to a lecture in "Snglish,

VTII. Outstanding Personality Traits. This category was
selected in order to make the salient features of the
subjects stand out and in order to give one a bird's
eye view of the personality of the patients. 'T^hose
characteristics which appeared to be of importance in
considering recreation were chosen, such as seriousness
or feelings of unreality.

IX. Occupational Therapy, "^his consists of sewing, weaving
of baskets and rugs, crocheting, drawing and the like.
The interests of the patients in these activities are
stimulated by a leader, the occupational therapist,
who assigns and interests the patients in the kind of
work that is recommended by the psychiatrist. '^he work
itself is said to have therapeutic value for the mental-
ly ill.

X. Physical Condition. Certainly a person with only one
leg will not be able to play baseball well, and a sick-
ly person of any kind would seem to be limited in the
form of recreation selected.

XI. Recreation before Hospitalization. Although it was
not always possible because of lack of data, it seemed
valuable to compare the recreation of the patients
before hospitalization and during their confinement.

XII. Religious Emphasis. The Methodist's condemnation of
dancing, at least in the past, is an illustration of
how one*s religious emphasis can influence one's re-
creation. Religion and recreation may be linked in
other ways , too .

XIII. Medication. It is obvious that those patients who
receive metrazol treatment are more capable of partici-
pating in recreation, if the treatment is successful.

other forms of medication probably have a less notice-
able effect.

XIV. Intelligence. Certain guessing games indicate that
not everyone can play them. To include a dull person
in a predominantly intellectual form of play would ap-
pear more like torturing the person than pleasing him.

XV. Recreation during Hospitalization. This section is
one of the most important in the study and consists of
the accumulated observations of the author and the nurses
on the wards from whicli the patients came.

XVI. Additional Comments. These were entered in this part
when they seemed to clarify the study of the recreation
of the patients.

It can be seen from considering the above factors
that recreation may be conditioned by a number of phenomena.
It would be unwarranted over-simplification to assume that
there is a single cause relationship between the type of re-
creation chosen and the form of mental illness. Although
much of the data on recreation were gathered from the author *s
own observations during the scheduled recreational period,
the data on occupational therapy and recreation on the wards
were supplied by others and were taken into consideration also.

CHAPTER rV

THE r.YENTY PATIENTS

After a concept of the recreational had been devel-
oped and conditions suitable for the study were found, twenty
patients were selected from the Adolph Meyer Building. In
order to make clear some of the terms used in describing the
characteristics of the patients in this study, it will first
be necessary to elaborate somewhat. Eor definitions of the

psychiatric terms the reader is referred to textbooks on
1

psychiatry.

All observations of the writer and of the nurses
on the wards were made between the dates of Dec. 1, 1940 and
Feb. 28, 1941. Although this time factor was selected in
order to limit the scope of the subject, it did not seem to
be especially significant for this study, since either pro-
gress or the lack of it, if observed during this period,
could not be attributed to the effect of recreation.

Although originally it was the intention to include
under ^medication* all kinds of drugs that any of the twenty
patients took within the specified time period, such close
calculation, in the face of seemingly more outstanding

1 'filliam A. 'Vhite, Outlines of Psychiatry, 11th
edition , (Washington : Nervous and Mental Disease ^ublish-
ing Co., 1926). The reader may, however, select others.

factors, did not seem necessary or advisable. Consequently,
'none' was consistently used if the patient received neither
metrazol nor electric shock treatment.

Case 1 did not stay in the Adolph Meyer Building
the full three months but was transferred February 10th to
another ward, since the psychiatrists felt that he was not
benefiting by the concentrated forces available in this
building. ^ince it was difficult to procure twenty patients
in the Adolph Meyer Building who met the conditions required,
this case was included in the investigation. Thirty cases
were originally studied, eleven of which during the course
of the three months left the building or the hospital for
one reason or another. It will be noticed that no psychoses
are included which have a predominantly physical basis for
them.

In treating the topic of intelligence it was
thought that a difference in the I. 7. of three points would
not make an appreciable difference in the type of recreation
the patient engaged in, so that 'low average', 'average',
'high average' and 'superior' were used instead, correspond-
ing respectively to 90-100, 100, 100-110 and 110-120 in I. Q.
In addition the intelligence quotient which is obtained by
testing a patient upon his entrance into the hospital is not
always even approximately near his pre-hospitalization

32

functioning. The intelligence ratings used are those ob-
tained by the hospital psychologist at the time of the pa-
tient's entry.

For the purpose of the study it did not seem neces-
sary to define * rural* in terms of exact nujnber of persons
within a circumscribed area, especially since this actually
gives no picture to the reader. Instead the term was used
to denote a farming district. In cases designated by 'urban'
a city district is understood.

The word 'American* refers to the place of birth,
although the significant aspect is that those so designated
are not of a foreign culture. Only one was found to be
otherwise.

Unless a patient had definitely extraordinary ideas
about religious phenomena, such as seeing visions, the char-
acterization 'not marked* was used. Even though a patient
attended church every Sunday and yet did not express any un-
usual phenomena in connection wi-*-h her devotion, or his, the
expression 'not marked' was used.

In discussing the physical condition of those in
the study, only gross defects were noted, such as a limp or
acne. The acne of case 4, which was on her face, made her
very self-conscious and limited her attendinf?; dances. Some
of the patients were thin and pale, although this was not

considered serious enough definitely to limit the recreation
chosen. Such malnutrition may be only for a short period of
time and may be allievated by proper attention to diet. In
fact a great many patients gain in weight during their stay
at the hospital.

'Outstanding personality traits' listed are those
which were prominent in the lives of the patients before they
were hospitalized. Perhaps most of the time there is a con-
tinuance of -Tiany of these traits into the hospitalization
period, although this does not seem to be always so. At
times perhaps the relatives and friends of the patients mis-
represent, without intention of doing so, the outstanding
personality traits of the patient before his commitment, and
there is an apparent contradiction between hospital and pre-
hospital behavior.

The recreation of the patients has been divided in-
to two parts, that on the wards and that during the recreation
al period. No observation by the writer of recreation on
the wards was made, the nurses providing all these data. The
time of day of the nurses' notes might be from early in the
morning to late in the evening. The occupational therapists
also supplied information.

The cases which were used in this study will be
designated by Arabic numerals so that it v/ill be easv to

34

refer to them and so that the identity of the persons in-
volved will be protected. The following are the cases:

Case 1_

I. 31 II. Urban III. Manic-depressive,

Manic IV. Silktwister V.^mite

VI. Single VII. American VTII. Very Serious
IX. Worked at rugs, although he had to be prodded. At times
patient would sandpaper wooden tables or chairs, but he did
not seem to do this with much eagerness. X. Cell
growth of the right foot causes the patient to limp

XI. Read a little, listened to the radio a great deal, liked
to accompany friends on deep-fishing trips, although he did
not actually fish on these trips. He liked to v/atch baseball
games. Played cribbage fairly well. XII. Altar

boy when young; previous to hospitalization, there were prom-
inent guilt feelings present, although patient claimed not
to know why he felt guilty. XIII.Metrazol treatment

given, although this did not seem to be effective in helping
patient. XIV. Low average XV. Took no part

in recreational activities or in any activities on the ward.

Case 2

I. 20 II. Rural III. Psychoneurotic

IV. None V. White VI. Single

VII. American VIII. Fears that the world is going to

35

end, that something terrible is going to happen to her mother,
that she will become immoral and indecent. She also has
feelings of inferiority. IX. Embroidery and clerical

work tried, although these did not seem to benefit the pa-
tient. Dramatics undertaken from which satisfaction was
obtained in spite of occasional fears. X. Tood, ex-

cept that the patient* s nose is unattractive. She has gaine<^
weight during her hospitalization period. XT. "Eng-

lish and dramatics with periodic attendance at dances. Usu-
ally, she went to dances with her brothers. XII. Not
marked XIII. None XIV. Above average, good
student XV. Patient was allowed to go downtown to
attend dances during her stay at the hospital. As already
mentioned she was in the Christmas play given at the hospi-
tal each year. She did well. In a group situation she
most often sought the company of a quite retiring and timid
female patient. When dance music played, patient usually
participated, as she did in all of the recreational activi-
ties, although she seemed retiring and fearful to some degree
Her handclasp during dancing was weak and a mild perspira-
tion would at times render her hand clammy. As a dancer
she was graceful. At other times she stood around the
piano with other patients and sang. Sometimes she would
not dance or sing but sit in a corner and keep very quiet.
XVI. Father approached patient sexually, although the

attempts made were not successful
for a male teacher in school.

Intense dislike was felt

Case 3

I. 14 II. Urban III. Schizophrenic-catatonic

IV. Student V. White VI. Single

VII. American VIII. Aggressive, energetic, bad tem-

per IX. Knitting, although she would often wish to

do just as she pleased X. Stocky in build* After

metrazol treatment she gained twenty-five pounds

XI. Dramatics, dancing, bicycle riding, roller skating

XII. Not marked XIII. ?'^etrazol with good results
xrv. Low average XV. On the ward patient romped
around with another patient while playing childish games.
During the recreational period she was aggressive, asking
first one man and then another to dance with her, these men i'
usually being other than the patients. No discrimination
seemed to be sharply made, however, between the patients and
those who v/ere not. A very graceful dancer, patient would
often perform solo tap dances in the center of the room.
Everyone would watch he r during these performances, and she
seemed to enjoy the attention which was usually showered upon
her. At times when she was dancing she would suddenly
leave her partner in order to finish the dance with another
person. She never seemed to be tired. X^tt, Father
suffered from mental illness and the mother has a bad temper.

37

Before hospitalization the patient believed that people were
saying things about her and that they were chasing her.

Case 4

I. 25 II. Urban III. Schizophrenic-hebephren-
Ic rv. Maid V. White VI. Single
VII. American VTII. Religious and serious

IX. Fine handwork, embroidery, creative at times in drawing

X. Good, except for acne on the face which cleared up after
treatment XI. Hrlee club during the first year high
school. Educational movies were attended. XII. Pro-
nounced. Patient saw visions on the walls of the church.
During her stay at the hospital she insisted upon writing to

a priest, showing a strong attachment to him.

XIII. Metrazol, the results of which were very favorable

XIV. Average XV. At first during the recreational
period the patient indicated no interest in her surround in^rs .
Gradually, however, as she began to take metrazol treatments,
she improved until she began to show signs of greater inter-
est in what was going on around her. At first her clothing
was plain and colorless, although as she showed more general
activity and interest, she began to wear brighter things.

As it became apparent that she was improving under metrazol
treatment, she was asked to dance, which she did well. Pre-
vious to her first dance at the hospital she had not danced
in a year. She remarked that she liked Spanish music, when

asked v;hat kind of music she liked, althoui^h even durins;
the recreational period she continued to talk about missionary
work and her priest. "Jhen it was learned that she used to
sing in the glee club at school, encouragement was given her
to try once more to sing somewhat, even though she might not
be skillful at it. Gradually, she aang a bit now and then
until she finally gathered around the piano and picked out
I some pieces she wished to sing. As she improved even more
she was observed asking other patients to dance. 'Then the
patient thought she was being observed she appeared to display
her graces. When she first danced with this writer, who is
the observer mentioned above, she thought that she had known
him someplace before. XVI, Patient felt that she was

losing control of her body. At times life-sized figures of
her father would appear to her. They were usually dressed

in alJkinds of weird costumes. She feared that her father

and grandfather were going to harm her. ^'other of this pa-
tient was also mentally ill; the only sister is feebleminded.

Case 5

I. 48

II. Urban

III. Psychoneurotic-hypochon

driacal

IV. Machinist helper

V. Black

VI. Married

VII. American

VIII. Somatic

complaints, although he is powerless to do anything about

I them.

IX. None, since he cleans the building in

which he lives, although this really may be occupational

39

therapy. X. O-ood, despite his somatic complaints
XI. Rode horses and boxed XII. Not marked

XIII. Physiotherapy XIV. Superior, with good mem-
ory XV. No attendance at recreational periods
XVI. Patient was the butt of jokes at his job, after which
he began to drink cheap wine, although he had never drunk
previously. He is well-liked on the ward by both the other
patients and the attendants.

Case 6

I. 49 II. Urban III. Psychoneurotic -reactive
depressive IV. Sailor V. ^Uhite
VI. Single VII. American VIII. Shy and
retiring IX. Tables made and also reed frame for
flower stand. He was usually fearful that he was not work-
ing quickly enough. X. Fairly good, although he has
a mild case of arthritis. Patient is of short stature. He
had a spinal fusion which causes him discomfort. In addi-
tion his right leg has been injured so that he limps.
XI. None. Patient was reported too busy to have time for re-
creation. XII. Not marked XIII. None

XIV. High average XV. During the recreational period
this man seemed pretty much at ease. He watched the other
patients dance and danced himself at times, although it was
difficult for him to do the Virginia Reel or to engage in
regular ballroom dancing, ^"^.nien he did participate in the

Virginia Reel, he would often swing his partner with a great
deal of vigor and recklessness. All the while he danced,
however, he continued to limp. Once or twice during one
evening he whistled quite shrilly, although the others in the
group did not seem to mind this. At other times he sang
with others around the piano. At one time he seemed unmind-
ful of another patient's playing and played the victrola at
the same time, so t^at the piano player could not make her-
self heard. On the ward the patient always seemed to be
happy and was usually willing to do anything asked of him.
XVI. During the World 'Var he was on a destroyer which was al-
most torpedoed. This experience sreatly frightened the pa-
tient. One of the noticeable things about the patient dur-
ing his hospitalization was that he developed a fairly good
sense of humor .

Case 2

I. 21 II. Urban III. Schizophrenic-simple

type IV. None V.^/hite VI. Single

VII. American VIII. "Feelings of unreality, shy

IX. 7/orked on newspaper of the hospital. She appeared afraid
to express any ideas of her own. X. f^rood. Patient

is six feet and two inches tall. She is quite thin.
XI. Patient did not care to read. She liked ejardening, ten-
nis, piano and the movies XII. Not marked
XIII. None XIV. High average XV. During

41

the recreational period the oatient usually plaved the piano
so that others might dance and sing. Her Diano playing is
fairly good. At times the patient practiced reading notes,
playing both classical and jazz. '^he nature of the music
was often centered around the theme of love. Most often
this patient danced with other female patients when she
danced. She appeared awkward on her feet, stooping over
as she danced. She always waited to he told what piece of
music to play. The quality of her music seemed to engender
some confidence in her. XVI. Patient was the only child
born to her parents. The father is very dependent upon his
wife. She puts his clothing out for him and babies him in
general .

Case 8

I. 54 II. Urban III. Manic-depressive, ^'^anic
IV. Jeweler and tool-maker V.''.Tiite ^^1. Mar-
ried VII. American VIII. 'thought himself
persecuted. Also believed himself to be a 'T-man .

IX. At first the patient did no work. (Gradually he began
to work at a bookcase. He repaired chairs, too.

X. Good XI. Wrote poetry XII. Not marked
XIII. ISIone XIV. Above average T^T. During
the recreational period patient did the Virginia Reel, al-
though he was quite serious about his performance. Only
once in a while did he speak to anyone. ^-ost of the time

r

1

he seeir.ed annoyed, frownin,^ at those around him. ^t times
when he danced he v^rould kick his heels high up in back of
him. He appeared to be a graceful dancer. XTl , Pa-

tient obtained a job in town but at the last moment seemed
unable to start work.

Case £

1 , 36 II. Urban III. Manic-depressive, Fanic

IV. Librarian V. V/hite VI. Single

VII. German Jew VIII. Serious and sensitive; easily

angered; resentful and critical IT. Enthusiastic and

helpful to the group. Fine needle work was avoided

X. Grood XI. Tennis, painting. Plavs flute well

XII. Not marked XIII. None XIV. Superior

XV. During the recreational period this patient often was
quite serious. Only occasionally did she show a little
laughter. At times she appeared sulky and seclusive.
Hardly ever did she associate freely vvrith the other patients,
although she exhibited fondness to a ereat degree for the males
present in the group. Sometimes these were patients but usu-
ally thev were not. '^'requently this patient became philo-
sophical, uttering proverbs concerned with serious topics.

XVI. Father of the patient was a prominent man in Germany.

He exhibited polyerotic tendencies. Consequently, patient's
home life was not hapoy. A few months before the patient
was hospitalized she came to this country. This may have

influenced her illness, since she was forced to leave Germany
because of her Jewish blood.

Case 10

I. 25 II. Urban III. Schizophrenic -catatonic

IV. Housework V. '¥hite VI. Single

VII. American VIII. Shy, autistic thinking; saw

angels IX. Rugs woven, needle work and drawing.

Quality of work and participation were good.
X. Good XI. Read, sewed and listened to the radio

XII. Saw angels XIII. Electric shock, which did

not seem to help the patient XIV. Low average

XV. Attempted some puzzles on the ward. Curinf? the recrea
tional period she would usually sit in a chair ^^Ithout moving.
Once she became slightly resistive. XVI, No interest

in men. Patient's great-grandmother was psychotic and her
brother is also in a mental hospital with the same diagnosis
of schizophrenia. Displaved a great deal of fussiness
about cleanliness.

Case 11

I. 21 H. Urban III. Schizophrenic-cataton-

ic rv. N.Y.A. worker V. '^mite

VI. Single VII. American VIII. No interest

in girls, few friends, temper; often fearful of something
unknown IX. Some baskets were v/oven, althous-h he

did his work very slowly and had to be prodded to work.

44

X. Good, except for a slight limp XT. ^wam, read,

listened to the radio and went to the movies XTI. At

times he would get on his knees as if praying

XIII. Metrazol, results not good XTV. High average
XV. Because patient did not know how to dance he was not able
to participate in that activity. Most of the time, he
would sit by himself, legs crossed, and silent. "-Tien he
talked about swimming he became enthusiastic and talked quite
a little about some famous swimmers. He once mentioned, in
talking about the times that he used to so swimminfr , that
those "were the good old days". XVI. Patient thought
that he was homosexual, that witches chased him. In school
he excelled in mathematics and bookkeeping.

Case 12

I. 16 II. Urban III. Simple

IV. Student V. "/hite VI. Sin^'le

VII. -American VIII. Wears feminine attire

IX. Rugs woven, although he had to be prodded

X. Good XI. Baseball, movies, Wild '"est stories

and comic strips XII. Not marked XTII . None

XIV. Lov; average XV. Color books were brought to
the patient at the hospital by his parents. He seemed to
enjoy coloring these with a crayon. Often he would pout
like a child of seven or eight. XVI. ^'other of the

patient has always been protective of him. He thinks that

he is seven different persons all at once.
Case 15

I, 37 II. Urban III. Schizophrenic-cataton-

ic IV. Housework V. White "^''T. Sing-

le VII. American VIII. Serious and reticient

with fiery temper IX. V/orked at rugs but did not

keep at job X. Good XI. ''^ovies and embroid-

ery XII. Guilt feelings. At times patient would

get on her knees in a prayerful attitude XIII. ^•'^etra

zol, improvement in the patient has since been shown
XIV. Average XV. Before metrazol treatment the pa-

tient was reticient, not dancing or even seeming at all in-
terested in the recreational period. Gradually, after a
few injections of metrazol, she began to play cards. She
was more attentive about her appearance, too. As she got
better she attended one of the dances held at the hospital,
although she seemed to become somewhat confused after the
dance was over and it was time to go home. T^tj. «^he

thought that the spirits were trying to kill her and that
people were laughing at her because of her bad reputation.
Patient often showed intense jealousy.

Case 14

I. 18 II. Rural III. Schizophrenic -mixed

IV. Student V. White VI. Single

VII. American VIII. Preoccupied, silly and irritable

IX. Liked to embroider, although she did not like to weave
rugs X. Good XI. Liked to sing

XII. Not marked XIH. Metrazol, poor results

XIV. Low average XV. Sang a great deal at home

XVI. Spread butter with thumb. Personal hygiene poor.
Mother is dull and the father is alcoholic. Sister of the
patient is schizophrenic .

Case 15

I. 42 II. Rural III. Involution Melancholia

IV. Housewife V. 'ITiite VI. Married

VII. American VIII. Serious, sensitive and quiet

IX. Embroidered. Demanding at times X. Good

XI. Embroidery and piano playing XII. Guilt feel-

ings XIII. Metrazol, condition improved

xrv. Unknown, no test given XV. This patient asked

for something to do on the ward as she began to improve.
For amusement she played cards and read. XVl, As a

child she played alone. Voices tell the patient that she
is going to be killed.

Case 16

I. 29 II. Urban III. Schizophrenic-catatonic

IV. Housework V. White VI. Married

VII. American "^i^III. Sensitive, seclusive and retiring

IX. "forked the loom, weaving rugs. She showed a great deal
of patience Xo Good XI. Dancing, tennis and

iceskating before she was married XIT. Not marked

XIII. None XIV. Low average XV. Patient

played cards on ward. Did not go down to the recreational
period XVI. ^Vhen the patient first came to the hospi-

tal she was tube-fed for a few days, after which she showed
improvement. Her husband is aggressive and domineerinj?? .

Case 17

I. 29 II. Urban III. Schizophrenic-catatonic

IV. Jewelry worker V. '^ite VI. '"arried

VII. American VIII. Quiet and sensitive

IX.. Does almost anything- rugs, embroidery, crocheting, knit-
ting and sewing. She often felt that her work was not very
good, although she usually did better than the majority of
patients. She was self-conscious, thinking that people were
talking about her. X. Oood XI. Bowled, went

to the movies. Read magazines, usually love stories
XII. Not marked XIII. None XIV. Low average

XV. Usually, when the patient first came to the hospital, she
would hide from others. Gradually, she associated with other
patients, playing cards with them. *^he herself thought that
this was a sign that she was gettirg better. She also worked
at puzzles. XVI. At home patienit slept only three or

four hours. During the day she would remain at home with the
curtains pulled dov^i .

48

Case 18

I. 32 H. Urban III. Manic-depressive, other

types IV. Housekeeper 7. White VI,

Single VII. American VIII. Excitable

IX. Patient liked to knit Red Cross sweaters, since she felt
then that she was doing something worthwhile. ^he sewed her
own clothes during the occupational period. She worked stead-
ily. X. (rOod XI. Painting and mystery stories
XII. Not marked XIII. None XIV. Average
XV. Patient spent much time on the ward knitting sweaters.
Frequent visits were made home. XVI. For the past
twelve years patient has been suffering from her illness.

Case 19

I. 51 II. Urban III. Manic-depressive, depres-

sive IV. Machinist V. White VI. Mar-

ried VII. American VIII. Sensitive

IX. Wove good baskets X. Good XI. Liked

movies, read with enjoyment XII. Quilt feelings
XIII. None XIV. Average XV. Patient, unable
to dance, usually watched the other patients dance. Once
he made an attempt at dancing, although he gave it up. His
performance was best when he felt that he had an audience.
XVT. As a child he was restless. Poor hyp:iene

-1

: Case 20

' I. 56 II. Urban III. Involution Melancholia

I

IV. Laborer V. V/hite VI. !'[arried

VII. American VIII. Jolly IX. ''/orked con-

tinually at baskets, since he liked to do this X. Fai

XI. Gardening, cards, basket-weaving and radio stories. He
also took care of bees. XII, Guilt feelings, thought

he was going to be killed XIII. None XIV. Av

erage XV. Little. Instead the patient did chores

on the ward. At times he smiled at amusing incidences.
XVI. Patient's daughter is schizophrenic.

ANALYSIS 07 THE DA^^A

Because of the limited number of cases used in mak-
ing this study, the full significance of each of the factors
designated by Roman numerals as conditioning the forms of
recreation selected will be lost, although certain tendencies
can be observed, which, if studied further, might be more
clearly determined. The important aspect, however, is the
meaningf ulness of the various types of recreation to those
who participated in them. More weight will be siYen to data
obtained from direct observation of the patients during the
recreational period, since a better understanding of attitudes
was gained in this way. It was not easy to estimate the de-
gree of participation on the part of the patients in recrea-
tional activities before hospitalization, since little atten-
tion is customarily paid to this nha se in taking histories.
The notes of the nurses and the occupational therapists about
the patients were valuable.

V/hen the relation of the age of patients to the kind
of recreation engaged in was considered, a division was made
between those under and over thirty years. A distinction
was also made between active and passive forms of recreation.
Active forms of recreation were dancing., bicycle riding,

tennis, roller skating, horseback riding, p-ardening, bowling,
needle work and swimming. Passive types were listening to
the radio, v;atching sports and attending: movies. "^^able T
shov;s the relationship between the age of the patient and the
kind of recreation selected, according to the categories used

'^^BLE I

RELATION OF AG"^
TO PASSITfE A^^■ ACTIVS RECREATION

Age

Total

Active

Passive

Number

Recreation

Recreation

Over

10

8

2

30

Under

10

8

2

30

Thus, there does not seem to be any relationship between the
age of the patient and the degree to which he was a partici-
pant in recreation, although two of the patients over thirty
engaged in the more vigorous forms of active recreation, such
as tennis and horseback riding, while the remainder of the
patients over thirty tended toward less strenuous active
recreation, such as embroidery and gardenin^r. "^his obser-
vation leads us to consider the relationship of the age of
the patient to indoor and outdoor recreation, "^able JJ in-
dicates this relationship.

LlBPvARY
BOSTON UNIVERSITY

SCHOOL OF SOCIAL WORK

TABLE II

RELATION OF AOE
TO INDOOR A^T) OUTDOOR RECREATION

Age

Total

Indoor

Outdoor

Number

Recreation

Recreation

Over

10

7

3

30

Under

10

3

7

30

Those over thirty show a tendency toward indoor and sedentary
recreation, while those under thirty show a tendency toward
outdoor recreation.

Since there were only three cases whose residence
was rural, no generalization can be made about these. Of
the seventeen others, nine participated or were active in var-
ious forms of recreation, while the remaining eight either
watched games or were passively entertained.

There seems to be a relation between the general
character of the recreation selected and the particular psy-
chosis involved, the manic patient selecting more vigorous
pastimes and the depressed patient expressing himself throu^
comparatively quiet modes of play. The two manic cases in
the study, 8 and 9, illustrate the recreational activities of
this type of patient, while cases 1 and 18, the depressed
patients, represent those of the depressed individual. It
was interesting to observe that case 9, as she changed from

53

1

a manic state to a depressed one, engao;ed in fewer vigorous
forms of play, such as dancing and dram.atics, to more subdued
ones, as painting and reading. Vo relation could be ob-
served between the catatonic form of illness and the type of
recreation selected, cases 3, 11, 16 and 17 engagins in active
forms of recreation, while the other "two catatonic patients,
10 and 13, selecting passive forms. Agrain, it v/ould appear
that the mode of recreation is related to the degree of ill-
ness, as cases 10 and 13 were two of the twenty studied who
were quite ill in comparison with the others of the group.
Two of the three psychoneurotic oatients, cases 2 and 5, exhi-
bited tencencies toward active forms of recreation, whereas
the other psychoneurotic patient, case 6, shov^ed no interest
in recreation whatever before he came to the hospital, since
he felt that he had no time for it. Cases 2 and 6 attended
the recreational period regularly and seemed to benefit by
it a great deal. Case 6, especially, seemed to lose much of
his anxiety about himself and seemed to relieve himself of
hostility through swinging his pf^rtner vigorouslv while danc-
ing and interrupting the piano playin^ of one of the other
patients. "^ince no generalization can be made about two
cases, the other cases will not be discussed, because of the
insufficient number.

That different psychoses appear in association with
characteristic reaction patterns toward recreational activity

receives confirmation from the experimental work of Rosen-

zweig and Shakow:

In a preliminary study of single play constructions by
ten paranoid and ten hebephrenic schizophrenic patients
and ten normal individuals, it was found that (1) the
schizophrenic patients responded favorably to the form
of play techniaue used; (2) typically different patterns
were discernible for the three groups of subjects in re-
spect to the general characteristics of their construc-
tions; (3) individual cases yielded some material of
psychiatric interest even in a single experimental ses-
sion.

It is recognizable that such experimental work to evaluate
the place of recreation in the lives of patients is in its
beginning stages, but it is possible that through recreation
much more can be understood about psychotic individuals and
more done to help them get well.

Another interesting feature of the experimental
work carried on by Rosenzweig and Shakow was thPit the play
materials used were very simple, wooden blocks, and that some
of the patients spent considerable time in building with them
as much as an hour. Case IE of this study spent much time
coloring the picture book brought to him at the hospital by
his mother. It may be that such emotionally immature forms
of recreation are those most suitable to regressed patients
and that the building of a house with blocks or the solving
of a simple puzzle has a great emotional significance to them

1 William M. Cameron, "The Treatment of Children in
Psychiatric Clinics with Particular Reference to the Use of
Play Techniques", Bulletin of Menninger Clinic , 4: 17E-9,
November, 1940.

'^here are too many different occupations represented
in this group of patients to be able to say much about this
factor. The important aspect, that of the attitude of the
patient toward his work, is missing. In perhaps every case
the work engaged in was a result of economic necessity and
not one of choice.

Case 5 was an exception to the group of patients in that
he is a Negro. It is possible that his recreation of boxing
and horseback riding are connected with his color. Boxing,
especially, may have been chosen as a means of expressing hos-
tility feelings developed from his ill-treatment by whites.
One of the accentuating factors in his illness was believed
to be that of his color, for raanv o"^ the men where he worked
used to make him the butt of their jokes, so that he became
extremely self-conscious about his race.

Case 9, a female G-erman Jew, the only person of a
different nationality, v^as certainly limited in her recrea-
tional expression in Germany because of her culture. ''Jhen
she came to this country she continued to feel sensitive
about her racial background. Perhaps it is for this reason
mainly that this patient engaged in solitarv forms of play.
She learned to play the flute well and paint skillfully.

The outstanding personality trait among those
studied seems to be that of seriousness. All the more

important woald the factor of recreation seem for these indi-
viduals, since whatever else recreation is, it is not serious.
In no case was there evident a sense of humor, although case 6,
a psychoneurotic, shov/ed a developini? sense o-^ humor as he
improved in mental health.

Cases 1 and 6 both suffered from their injured limbs.
This prohibited their plavim to the same extent as other per-
sons. In spite of his limp, case 6 at times danced durin^r
the recreational period. The remainder of the group did not
seem to be seriously affected by their physical condition,
even though some of them were not in the best of health.

Occupational therapy may be considered as either
work or play, depending upon the attitude of the individual
patient toward it . Table III shows the attitude of the pa-
tients toward occupational therapy as judged by the writer.

TABL^ III

OncIJPmON^L THERAPY
AS 'YORK OR PLAY

No. of Patients

Ma le

"^eraa le

Work

9

5

4

Play

10

2

8

Total

19

7

12

Only nineteen patients are included in this consideration,
since one subject did no+ have any occupational therapy at
all. Those v/ho considered occupational therapy play did not
necessarily like more than one or two forms, while those who
considered occupational therapy work indicated no liking at
all for any form.

The number of patients who expressed a liking for
occupational therapy and those who did not is almost equal,
although the female patients showed a greater interest than
the males. The difference in interest seemed to lie in the
great liking of the women for embroidery and knitting. Em-
broidery appeared to be more interestinf' to those women who
had marked guilt feelings. See 'T'able IV.

TABLE IV

RKLirrlOUS ^ESLINOS
AI^JD ATTITUDE T0V/ARI5 E?.1BR0IDERY

Number
of

Patients

No
Special
Liking

Special
Liking

Vv'omen with

feelings
"not marked"

8

3

5

'.Vomen v;ith
feelings
"marked"

4

0

4

Totals

12

3

9

It may be that the delicate 'work' of embroidery is an expres
sion of the sensitive feelings so closely associated with

religion. There does not seem to be any relationship be-
tween the religious interests of the males and their recrea-
tion, although the number is not sufficient to tell.

In those three cases in v^hich metrazol treatment
was effective, 3, 4 and 13, there was an awakening of interest
in the general activity about them and a concomitant interest
in plav was shown. All three, although they had not danced
before their medical treatment, did so as they began to im-
prove .

Case 9 displayed an interest in artistic phenomena
and played the flute well. In addition to this she was able
to learn the English language after having been in this coun-
try only a few months. Her interest in learning to speak
another language bordered on plav. '.Vithout her very superior
intelligence she could not have enjoyed learning to speak
English or she could not have amused herself by dealing in
witticisms. Case 12, on the other hand, a patient of low
intelligence, was interested greatly in comic strips and '"fild
"Nest stories. His mother brought him a simple book of pic-
tures to be colored with a crayon, T«'hich he did with a sreat
deal of interest. Here a-^ain seemed to be an illustration,
of the influence of the intelligence factor in determininQ"
the mode of activity one engages in for play.

!//ith respect to the marital status of the patients

I

no differentiation v/as made between the types of recreation
engaged in before and after marriage, except in case 16, a
female who used to dsnce, play tennis and ice-skate before
marriage but not after.

The important aspect of the activities the patients
choose is the value such forms of recreation have to them in
giving expression to their personalities. Earlier in this
study nine fundamental psychological needs of the individual
v^ere listed as elements expressed through recreation. It
is evident that physiological benefits in the form of in-
creased circulation is the result of recreation, although
here attention will be focused on the psvcholos-ic al side.
Each of the nine basic psychological needs of the individual
will be considered with. respect to the twenty patients stud-
ied.

1. Freedom of the individual to select the activity
in which he engages.

All of the patients prior to their hospitalization
had the opportunity to select those forms of recreation they
v/ished. After hospitalization all of the patients had some
loss in selecting their own forms of recreation, although
usually patients, v/hen left alone, show little interest for
any activity whatever and have to be led to a large extent.
All the patients whom the psychiatrists i^eel vdll profit from
the recreational period are made to attend, although these

60

do not therefore enter into the recreation. In the majority
of cases, ho^vever, there is a willingneps to enter into the
activities of this group. As the patients gain in mental
health this feeling and desire to participate becomes stronger
Gases 2, 7 and 9 during the three month period of this study
were allowed great freedom in doing v./hat they v/ished for re-
creation, not being made to attend the full lenf*th o"^ time
the recreational period. Case 7 often amused herself by
playing the piano, v^hile case 9 was given a room in which she
was free to paint whatever she wished. Several fairly good
pictures were painted by the latter. The other seventeen
patients were restricted in their recreational activities,
being allov^ed merely to attend the recreational period and to
play on the wards.

2. Expression in terms of reality rather than phan-
tasy.

It is not ^n easv natter to estimate this factor,
since many of the patients can oarticipate in the recreation
and at the same time carry on a process of autistic thinking.
It seems justifiable to say that those patients who sins- and
dance are making some adjustment to reality, even though they
may at the same time be occupied with phantasies. Cases 1
and 11 did not engage in any kind of recreation and expressed
phantastical notions. Case 4, as she danced more and more,
seemed to be less preoccupied. Instead of sitting in her

chair, as she did previously, before her raetrazol treatment,
she sang and. danced, even askin,^ other female patients to
dance v/ith her. No clear evidence indicated how the other
seventeen were adjusting to reality.

3. Release from depression and self -accusation .

Recreation for the depressed patients and the invo-
lution melancholia ones, of which there were three and two
respectively, helped them keep their minds off themselves*
Case 1, however, did not engage in any recreation at all and
consequently did not utilize this means of overcoming his
depressed feeling. Even though urging was used it was of
little avail and this patient had to be shifted to another
ward. The other patients were not predominantly depressed.

4. Superiority expression, measured in respect to
a group of other persons.

T\vo of the patients in this study would have little
to do with other patients, associating primarily when the
opportunity arose with members of the hospital staff. Case
9, the German Jew, exhibited a marked tendencv to gain social
status within the patient group. Perhaps her feeling of so-
cial inferiority caused her to seek more social recognition
than the other patients. It is characteristic of many pa-
tients in the hospital to seek recognition from the staff
members of the hospital. The other patient v;ho associated

62

little with the other patients was case 2. No marked striv-
ing for a place in the group was observed in the other patients.

5. Sociability of subjects, measured with regard
for the extent and character of its expression.

Almost all the patients exhibited a tendency to
form a circle of friends within the patient group, not asso-
ciating to a great extent with the others, although this
happens in human affairs everywhere and may be looked upon
as usual. Of the three successful metrazol treatments two
were much more sociable after a few shocks, cases 3 and 4.
At the time the three month period closed, the other patient
showed some signs of sociability but only a little. 'lase 3
talked and responded to all the patients who were well enou^?;h
to do so. Exactly half the schizophrenics, five in number,
kept to themselves pretty much. None of the patients, ex-
cept case 3 after metrazol treatments, was excessively social.

6. Experience of greater security.

The two psychoneurotic patients in the group, cases
2 and 6, seemed to derive a greater feeling of security than
the others. Perhaps this was because their illness is so
closely associated vvith unresolved fears and hostilities
which were partially allowed vent during the recreational
period. Case 6, in particular, seemed to show hostility
by playing the victrola loudly, swing ins; his partner vigor-
ously and whistling shrilly when other activities were on,

although he did not display this aggressive behavior outside
I recreational activities. Ml of these acts served to make
him more the center of attention.

7. Esthetic experience.

Cases 4, 7, 12 and 13 had definite feelings of being
forced to do things they did. not choose to do. They felt as
though they had lost control over their bodies and that they
were mysteriously being directed by spirits or unknown influ-
ences. No such feeling was known to exist in the other cases
Cases 4, 7 and 13 were able to dance during the play period,

jl This experience of controlling their o^/m bodies probably en-

■

! abled them to experience considerable satisfaction, although
no really definite statement can be made about this.

jl

I 8. Mastery of self or an object.

, This factor is closely related to the above. Al-

though many of the patients when they enter the hospital are

i

I able to experience a feeling of mastery from dancing, most of
them, unable to dance, gain this same satisfying feeling from
work in occupational therapy. All the patients did some
creative work or finished an object during occupational ther-
apy with the exception of cases 1, 3, 7, 11, 12 and 13.

9. Desire for new experience.

ij No evidence was obtainable to indicate the feelinss

i'

of the patients in this respect with the exception of the

i

psychoneurotic patient, case 6, who said explicitly thit he
liked to do new things and see new people and that he became
tired of the same activities all the time. His desire for
new experience seemed to be greater than is commonly found
among so-called normal individuals.

Although all the above factors seem to be important
needs of the individual that can be satisfied through the
medium of play, it is evident from the material in this study
that some patients with one type of psychosis require satis-
faction of one need to a greater degree than other patients.
The psychoneurotic, for example, must strive hard to feel
secure, whereas other patients, as the schizophrenics, need
greatly to develop sociability.

CHAPTER YI

CONCLUSIONS AND R-5C0!.fmTD/\'T^T0NS

li Method ;

After the concept of recreation had been developed
j in the first chapter of this study, it was necessary to find
! a way of studying it. "^ince the basic element of the recre-
ational v^as postulated to be attitudinal in nature, it seemed
necessary to use a method that would show how the recreational
life of the person was related to other activities, the expec-
tation being that the same attitudes of a particular person
would be reflected in any activities engaged in by that per-
son.

But limitations of many kinds modify direct expres-
sion of our desires, making it impossible to demonstrate a
clear one to one relationship between a certain form of re-
creation and another activity, and it seemed that factors
such as age, residence, color and so on had to be considered
as these appear also to influence one's recreation apprecia-
bly. Factors in addition to the ones selected may well have
been included in this study. The sex of the patients un-
doubtedly determined their recreation and was f?iven consider-
ation in this paper, although it was not specifically singled
out in the way age, residence, color and so on were.

The basic needs of the individual that reouire ex-
pression for the full develop-^-ent of personality were purpose-
ly selected so as to make the comparison of the mental illness
and recreation in an individual case easier, care being taken,
nevertheless, to express accurately and fully the real needs
of personality. Other ways of viewing the fundamental needs
of personality might have been used, although such a listing
as presented in thi? study seemed satisfactory. The limited
number of cases did not yield definite enough conclusions,
however, and it would probably have been more productive if
a larger number of cases had been considered.

Although the statistical method misht well be used
to indicate actual relationships between recreation and other
activities of the person's life, the evalu.^tion of the rela-
tionships as satisfactory or otherwise must still be made,
and these evaluations will be made 'possible only by a more
complete comprehension of the meaning fulness of a person*s
recreation as related to his life pattern. The case by case
consideration, therefore, seems to be basic if recreation is
a function of the individual's needs.

Find ings :

Because of the very limited number of cases included
in this study and because of the complexity of the subject,
few definite statements can be made about the available data.
Certain apparent tendencies, however, will be indicated.

I

(

I

I

I

67

-t^lthough there seems to be a modification of one*s
recreation by such factors as age, residence, culture, color
and the others mentioned in this study, the degree of mental
health seems to be more determinative of recreational inter-
ests and participation. Those patients, cases 1, 10 and 11,
who were more seriously ill than the others indicated little
interest in recreation during their stay at the hospital, al-
though these three cases v/ere active in recreation before hos-
pitalization. As patients imnroved because of metrazol shock
they reflected their improvement by showinf? more interest in
attending dances and the like. Cases 3, 4 and 13 were in this
category.

Occupational therapy was recreation to some of the
patients, although it is often considered work. The women
in the study looked upon occupational therapy as recreational
more frequently than did the men, although this was probably
greatly influenced by the fact that women were able to cro-
chet and embroider, activities often spontaneously chosen by
females, although the men, restricted because of the winter
weather from engaging in baseball and other sports outdoor,
were not given such wide choice of occupational therapy and
were not as able to select an activity to their liking.

Of the women who embroidered those who had ♦marked
religious feelings', four in number, all liked the activity,
whereas only five out of eight of those who did not have

♦marked religious feelings' liked embroidery. The delicate
♦work' of embroidery may be an expression of th<= sensitive
feelings so closely associated with religion and perhaps in-
dicates the relationship between the total feeling tone of
the individual and the expression of it through a specific
activity .

A sense of humor v;as not found in any of the cases
with the exception of case 6, who gradually showed signs of
a budding sense of humor as he got well, although when he
first was hospitalized he v;as fearful, almost panicky, and
exhibited no laughter at all but only seriousness. Perhaps
more could be done in the way of helping patients develop a
sense of humor, although it is probable that this would have
to be done on an individual basis, since what is funny to one
person is not at all funny to some others. '^he hebephrenic
patient is an illustration of this, since it is difficult to
see V(;hat is funny about some of the things he is silly about,
such as the death of his mother or a broken leg. It mav be
that his silliness is a strenuous but unsuccessful attempt
to 'laugh off' his troubles.

Mental illness is an emotional sickness. Instead
of exhibiting the accepted normal emotion toward their ex-
perience, these individuals, for one reason or another, fail
to respond in the customary way. This abnormal emotional
response may consist in being excessively joyful, sad or

i;

t

69

anxious when there is no apparent situation to warrant such
a reaction. It may be that since the emotional outlook of
the patients is different from that of ordinary persons, that
what is presented to them as a recreational activity really
is not, especially if the character of an activity is recrea-
tional according to one^s attitude toward it, a view dis-

1

cussed earlier in this work. To support this conjecture
there is the evidence of two schizophrenic patients in this
study who, although they v^^ere resistive to the form of re-
creation available during the regular evening period, enga^red

p

in puzzle solving of their ovn accord."^ One o-^ them thought
that she must be improving, since she shov^ed an interest in
games.

Since it is the rule rather than the exception for
the patients at the State Hospital for Mental Diseases of
Rhode Island to have their recreation in groups, the social
influences are important to take into account. Frequently,
patients beco-^e adjusted to the hospital group but must make
another group adjustment to the community when they leave the
hospital, although almost everyone is continually making read
justments to different groups, but the social situation in a
hospital, because it is composed of ill persons, is not the
same as one outside the institution.

1 page 13

2 cases 10 and 17

I

One of the primary differences between the group
situation the patient finds inside and outside the hospital
is in the degree to which his or her idiosyncrasies are ac-
cepted. The anxiety of the psychoneurotic patient, for exam-
ple, is not looked upon as outstanding in the hospital group i
although as soon as he exhibits the same behavior in another
group outside the hospital he is marked as *queer', the effect
of which is to accentuate his feelings of fear. In the hos-
pital group a patient is able to feel some sense of social
position, although upon leaving and associating with another
group, the sense of inferiority is more marked.

The room in v;hich regular recreational activities
were periodically held for the patients aopeared to be valu-
able as a type of place to carry on social functions. '^he
bright atmosphere, afforded by the indirect lighting and the
green colored walls, lent a stimulating effect to the situa-
tion, which seemed to be valuable in arousing patients to
participation .

Further Research :

One of the general conclusions that can be made is
that recreation needs to be studied more "^or its possibilities
as a means of expressing fully the needs of human nature.
On the basis of further experir^ental studv more ade'^uate plans
can be made for providing truly recreational activities for
our populace. Suggestions for further studying recreation

c

t

among patients follow:

1. Since recreation appears to be associated v,'ith
one's attitudes rather than with particular activities, it
might be profitable to study the reaction of reerressed pa-
tients, who seem to be child-like in their interests, toward
clay modeling, painting and play with v/ooden blocks.

2. "-^ince work and play seem to be closely related
an investigation of the relation of the patients* attitudes
toward their work and play v/ould perhaps be valuable. A
mere listing of the occupations would not reveal the attitude
of the patients tov«/ard their work, since most persons are
forced by economic necessity to pursue the work they do. It
might also be profitable to investigate the relation of work
and play attitudes in so-called normal individuals.

3. The problem of studying the value of recreation
in aiding, the recovery of patients is complicated by the med-
ication received, although this is not true of the psychoneu-
rotic patient, who looks upon the hospital largely as a re-
fuge from pressures of the world. From studying the two
psychoneurotic patients in the group, it seemed as though
they benefited to a great degree from the recreational activ-
ities, deriving from them a senF-e of security and recognition.
An investigation of this type of patient might be, conseouent-
ly, instructive.

5

t

BIBLIOGRAPHY

Brill, A. A., "The Mechanisms of V/it and Humor in Normal and
Psychopathic States", The Psychiatric Quarterly, 14:741,
October, 1940.

Cameron, V/illiamM., "The Treatment of Children in psychiatric
Clinics with Particular Reference to the Use of Pliy Tech-
nioue", Bulletin of Mennin^er Clinic, 4:172-9, November,
1940.

Cannon, 'Valter B., Bod ilv Changes in Pain , Hunger , Fear and
Rage . New York and London, D. Appleton and Co . , 1925 .

Chase, Stuart, "What Makes the Worker I, ike to Work?", Reader * s
Digest . pp. 15-20, February, 1941.

Dewey, John, Interest and Effort in Education, The Houghton
Mifflin Co., New York, 1913.

Dewey, John, Human Nature and Conduc t , New York: Henry Holt
and Co., 1922

Dooley, Lucile , "The Relation of Humor to Masochism", '^he
Psychoanalytic Review, 28: 37-46, January, .1941.

G-roos, Karl, The Play of Animals . New York: D. Appleton and
Co., 1898.

Lee, Joseph, Play in Education , New Vork: The MacFillan Co.,
1918.

Lehman, H. C. and Witty, P. A., The Psychology of Play Activ-
ities. New York: A. 3. Barnes and Co., 1927.

Mitchell, Elmer D. and Bernard 3. Mason, Theory of Play, New
York: A. 3. Barnes and Co., 1935.

Murphy, Gardner, Lois Barclay Murphy and Theodore M. Nev/comb,
Experimental 3oc ial Psychology, New York and London:
Harper and Bros., 1937.

Patrick, G. , W., '^he Psychology of Relaxation, Boston and
New York: Houghlon and Miff lin^C'o . , 1918.

Rosenzweig, Saul and David Shakow, *Tlay 'T^echnioue in Schizo-
phrenia and Other Psychoses", ^he American Journal of
Orthopsychiatry, 7: 32—35, January, 1937.

'/••Tiite, 'Villiam A., Outlines of Psychiatry, 11th ed., "Washing-
ton: Nervous and Mental Disease Publishing: Co., 1986.

Williamson, M.A. , The Social "/orker in 'T-roup 'YorV , New ^ork :
Harper and Bros . , 1929 .

Ziegler, Lloyd, "A Study in Occupational "therapy for Psycho-
neuroses", Archives of Occupational Therapy. 1: 457,
•December , 1922 .

A

BOSTON UNIVERSITY